He was seen by his GP 2 weeks prior to this with similar pain and was diagnosed with a groin strain.
1. What would you look for on clinical examination?
- Look – is he weight-bearing? Any scars, swelling, skin changes? (specifically does he have a limp, or is he out-toeing?)
- Feel – Any palpable tenderness, warmth?
- Move – Passive and active. Does he have reduced painful internal rotation and reduced abduction?
2. What might you consider in the differential diagnosis?
- Groin strain
- Slipped Upper Femoral Epiphysis (SUFE)
- Osteitis pubis
- Septic arthritis
- Stress fracture/pelvic fracture
- Avascular necrosis
3. What does the X-ray show?
- The X-ray, although subtle shows a left sided slipped upper femoral epiphysis = SUFE.
- The classic X-ray sign of this is that the femoral head looks like a ‘melting ice-cream’. (This is more obvious in this case on the post-operative films). More subtle SUFEs need to be assessed using Kline lines. (see the further reading section).
4. What are the risk factors for this condition?
- Boys are three times more likely to get this condition than girls.
- The peak onset is early teenage years (age 13) (although girls tend to get it a little younger due to earlier puberty – age 11).
- It is commoner in the left hip than the right
- It is bilateral in 20-40%
- There is the possibility of a genetic susceptibility.
- Endocrine disorders
5. How should the patient be managed?
- Follow the limping child pathway
- If suspected – bed-rest and refer to orthopaedics for surgical fixation
6. What are the complications of this condition?
- Avascular necrosis of the femoral head
- Chondrolysis (degeneration of the articular cartilage)
7. What is the Southwick Angle?
- This is a radiographic angle used to measure the severity of a SUFE.